Healthcare Provider Details

I. General information

NPI: 1295795599
Provider Name (Legal Business Name): JOHN PANEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9995 CARMEL MOUNTAIN RD
SAN DIEGO CA
92129-2889
US

IV. Provider business mailing address

637 3RD AVE
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax: 858-240-6470
Mailing address:
  • Phone: 844-200-2426
  • Fax: 619-356-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number248
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: